Adults with schizophrenia, bipolar disorder, and severe depression are at exceptionally high risk of poor functional outcomes and premature mortality from suicide, cardiometabolic diseases, and other hazards. Pervasive deficiencies in continuity and quality of care contribute to these dismal long-term outcomes. Evidence-based interventions of particular promise for large-scale improvement involve: 1) metabolic monitoring to improve early detection and guide ongoing management of abnormalities in glucose and lipid metabolism; 2) coordination of care transitions following hospital discharge to reduce the risk of early treatment disengagement and hospital readmission; and 3) appropriate use of uniquely effective and potentially lifesaving medications including clozapine, lithium, and long-acting injectable antipsychotic medications. SMINET will build on an established multi-state consortium to implement a set of metric-based, sustainable continuous quality improvement interventions to increase uptake, on a broad scale, of evidence- based practices to address these critical mediators of poor outcomes. SMINET will adapt, across large state systems with differing policy environments, strategies that have been successfully applied in participating states to improve these care processes. We will: 1) form state quality improvement workgroups focused on the three target practices, develop baseline quality profiles, and perform problem analyses within each state; 2) develop and implement state-level quality improvement plans and interventions using quality metrics and policy tools supported by evidence briefings to increase use of the selected evidence-based practices; and 3) monitor progress of the QI interventions, incorporate the metrics into ongoing administrative processes, and nationally disseminate the most successful intervention strategies. The consortium will engage state Medicaid and mental health leadership, and other key stakeholders, from Missouri, Wisconsin, Texas, California, Washington, and Oklahoma, currently serving 193,000 adults with severe mental illnesses. We will build directly on methods developed under our AHRQ-funded MEDNET project which engaged these state Medicaid agencies in improving safe use of antipsychotic medications. We will implement a five stage quality improvement process including: 1) baseline quality profiles and problem analysis; 2) identification of intervention strategies, provision of evidence-based education and technical assistance; 3) development and implementation of state quality improvement plans and interventions; 4) deployment and incorporation of metrics into ongoing care processes and impact evaluation; and 5) local and national dissemination. States will follow this sequence for each of the three evidence-based practices. The project will increase uptake, on a broad scale, of a key set of measurable, modifiable, underutilized evidence- based practices that have significant potential for improvement in outcomes, through a sustainable strategy that integrates measurement and education with policy tools available to state and managed care payers.